<p><strong>OBJECTIVE: </strong>Efforts to decrease hospital revisits often focus on improving access to outpatient follow-up. Our objective was to assess the relationship between perceived access to timely office-based care and subsequent 30-day revisits following hospital discharge for four common respiratory illnesses.</p>

<p><strong>METHODS: </strong>This was a prospective cohort study of children 2 weeks-16 years admitted to five United States children's hospitals for asthma, bronchiolitis, croup, or pneumonia between 7/2014-6/2016. Hospital and ED (in the case of croup) admission surveys administered to caregivers included the Consumer Assessments of Healthcare Providers and Systems (CAHPS©) Timely Access to Care. Access composite scores (range 0-100, higher score indicating better access) were linked with 30-day ED revisits and inpatient readmissions from the Pediatric Health Information System (PHIS). The relationship between access to timely care and repeat utilization was assessed using multivariable logistic regression adjusting for demographics, hospitalization, and home/outpatient factors.</p>

<p><strong>RESULTS: </strong>Of the 2,438 children enrolled, 2179 (89%) reported an office visit in the last 6 months. Average access composite score was 52.0 (standard deviation 36.3). In adjusted analyses, higher access scores were associated with higher odds of 30-day ED revisits (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.02-1.13) - particularly for croup (OR 1.17; 95% CI 1.02-1.36) - but not inpatient readmissions (OR 1.02; 95% CI 0.96 - 1.09).</p>

<p><strong>CONCLUSIONS: </strong>Perceived access to timely office-based care was associated with significantly higher odds of subsequent ED revisit. Focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.</p>

<p><strong>BACKGROUND: </strong>The use of inhaled corticosteroid (ICS) medications has been shown to improve asthma control and reduce asthma-related morbidity and mortality. Two recent randomized trials demonstrated dramatic improvements in ICS adherence by monitoring adherence with electronic sensors and providing automated reminders to participants to take their ICS medications. Given their lower levels of adherence and higher levels of asthma-related emergency department (ED) visits, hospitalizations, and death, urban minority populations could potentially benefit greatly from these types of interventions.</p>

<p><strong>OBJECTIVE: </strong>The principal objective of this study will be to evaluate the feasibility, acceptability, and limited efficacy of a text message (short message service, SMS) reminder intervention to enhance ICS adherence in an urban minority population of children with asthma. We will also assess trajectories of ICS adherence in the 2 months following asthma hospitalization.</p>

<p><strong>METHODS: </strong>Participants will include 40 children aged 2-13 years, who are currently admitted to the Children's Hospital of Philadelphia (CHOP) for asthma, and their parent or legal guardian. Participants will be assigned to intervention and control arms using a 1:1 randomization scheme. The intervention arm will receive daily text message reminders for a 30-day intervention phase following hospitalization. This will be followed by a 30-day follow-up phase, in which all participants may choose whether or not to receive the text messages. Feasibility will be assessed by measuring (1) retention of the participants through the study phases and (2) perceived usefulness, acceptability, and preferences regarding the intervention components. Limited efficacy outcomes will include percent adherence to prescribed ICS regimen measured using Propeller Health sensors and change in parent-reported asthma control. We will perform an exploratory analysis to assess for discrete trajectories of adherence using group-based trajectory modeling (GBTM).</p>

<p><strong>RESULTS: </strong>Study enrollment began in December 2015 and the intervention and follow-up phases are ongoing. Results of the data analysis are expected to be available by December 2016.</p>

<p><strong>CONCLUSIONS: </strong>This study will add to the literature by providing foundational feasibility data on which elements of a mobile health text-message reminder intervention may need to be modified to suit the needs and constraints of high-risk urban minority populations.</p>

<p><strong>TRIAL REGISTRATION: </strong>Clinicaltrials.gov NCT02615743; https://www.clinicaltrials.gov/ct2/show/study/NCT02615743 (Archived with WebCite at http://www.webcitation.org/6ji59rAXN).</p>